Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence

Arun Seshachalam, Shashidhar V. Karpurmath, Krishnakumar Rathnam, S. Ganapathi Raman, Murugesan Janarthinakani, Krishna Prasad, Channappa Patil, Parameswaran Anoop, Neelesh Reddy, Satish Kumar Anumula, Sirigeri Prabhakar Roopa, Krishna Reddy Golamari, Madhav Danthala, Prasad Gunari, Basawantrao Malipatil, Bharath Rangarajan, Karthik S. Udupa, Manjunath Nandennavar, Kesavan Niraimathi, Hemant Deepak Shewade

Research output: Contribution to journalArticle

Abstract

PURPOSE: Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS: This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS: The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS (P < .000). CONCLUSION: Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.

Original languageEnglish
Pages (from-to)1-13
Number of pages13
JournalJournal of global oncology
Volume5
DOIs
Publication statusPublished - 01-11-2019

Fingerprint

Hodgkin Disease
Positron-Emission Tomography
Disease-Free Survival
Bleomycin
Doxorubicin
Survival Rate
Tomography
Procarbazine
Dacarbazine
Survival
Vinblastine
Vincristine
Etoposide
Prednisone
Tertiary Care Centers
Cyclophosphamide
India
Cohort Studies
Multivariate Analysis
Costs and Cost Analysis

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Seshachalam, A., Karpurmath, S. V., Rathnam, K., Raman, S. G., Janarthinakani, M., Prasad, K., ... Shewade, H. D. (2019). Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence. Journal of global oncology, 5, 1-13. https://doi.org/10.1200/JGO.19.00179
Seshachalam, Arun ; Karpurmath, Shashidhar V. ; Rathnam, Krishnakumar ; Raman, S. Ganapathi ; Janarthinakani, Murugesan ; Prasad, Krishna ; Patil, Channappa ; Anoop, Parameswaran ; Reddy, Neelesh ; Anumula, Satish Kumar ; Roopa, Sirigeri Prabhakar ; Golamari, Krishna Reddy ; Danthala, Madhav ; Gunari, Prasad ; Malipatil, Basawantrao ; Rangarajan, Bharath ; Udupa, Karthik S. ; Nandennavar, Manjunath ; Niraimathi, Kesavan ; Shewade, Hemant Deepak. / Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence. In: Journal of global oncology. 2019 ; Vol. 5. pp. 1-13.
@article{bbe842ba1f3b4f41ac37e0673051a869,
title = "Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence",
abstract = "PURPOSE: Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS: This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS: The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63{\%} underwent PET-based staging and 37{\%} underwent computerized tomography (CT) staging. Stage IV (28.9{\%}) and bone involvement (9.2{\%}) were seen more often with PET than with CT staging (9.2{\%} and 2{\%}, respectively). Among 171 patients with iPET2 results, 24{\%} did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78{\%} and 97{\%}, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90{\%} and 99{\%}, respectively, whereas these were 65{\%} and 100{\%}, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS (P < .000). CONCLUSION: Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.",
author = "Arun Seshachalam and Karpurmath, {Shashidhar V.} and Krishnakumar Rathnam and Raman, {S. Ganapathi} and Murugesan Janarthinakani and Krishna Prasad and Channappa Patil and Parameswaran Anoop and Neelesh Reddy and Anumula, {Satish Kumar} and Roopa, {Sirigeri Prabhakar} and Golamari, {Krishna Reddy} and Madhav Danthala and Prasad Gunari and Basawantrao Malipatil and Bharath Rangarajan and Udupa, {Karthik S.} and Manjunath Nandennavar and Kesavan Niraimathi and Shewade, {Hemant Deepak}",
year = "2019",
month = "11",
day = "1",
doi = "10.1200/JGO.19.00179",
language = "English",
volume = "5",
pages = "1--13",
journal = "Journal of global oncology",
issn = "2378-9506",
publisher = "American Society of Clinical Oncology",

}

Seshachalam, A, Karpurmath, SV, Rathnam, K, Raman, SG, Janarthinakani, M, Prasad, K, Patil, C, Anoop, P, Reddy, N, Anumula, SK, Roopa, SP, Golamari, KR, Danthala, M, Gunari, P, Malipatil, B, Rangarajan, B, Udupa, KS, Nandennavar, M, Niraimathi, K & Shewade, HD 2019, 'Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence', Journal of global oncology, vol. 5, pp. 1-13. https://doi.org/10.1200/JGO.19.00179

Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence. / Seshachalam, Arun; Karpurmath, Shashidhar V.; Rathnam, Krishnakumar; Raman, S. Ganapathi; Janarthinakani, Murugesan; Prasad, Krishna; Patil, Channappa; Anoop, Parameswaran; Reddy, Neelesh; Anumula, Satish Kumar; Roopa, Sirigeri Prabhakar; Golamari, Krishna Reddy; Danthala, Madhav; Gunari, Prasad; Malipatil, Basawantrao; Rangarajan, Bharath; Udupa, Karthik S.; Nandennavar, Manjunath; Niraimathi, Kesavan; Shewade, Hemant Deepak.

In: Journal of global oncology, Vol. 5, 01.11.2019, p. 1-13.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Does Interim PET Scan After 2 Cycles of ABVD Predict Outcome in Hodgkin Lymphoma? Real-World Evidence

AU - Seshachalam, Arun

AU - Karpurmath, Shashidhar V.

AU - Rathnam, Krishnakumar

AU - Raman, S. Ganapathi

AU - Janarthinakani, Murugesan

AU - Prasad, Krishna

AU - Patil, Channappa

AU - Anoop, Parameswaran

AU - Reddy, Neelesh

AU - Anumula, Satish Kumar

AU - Roopa, Sirigeri Prabhakar

AU - Golamari, Krishna Reddy

AU - Danthala, Madhav

AU - Gunari, Prasad

AU - Malipatil, Basawantrao

AU - Rangarajan, Bharath

AU - Udupa, Karthik S.

AU - Nandennavar, Manjunath

AU - Niraimathi, Kesavan

AU - Shewade, Hemant Deepak

PY - 2019/11/1

Y1 - 2019/11/1

N2 - PURPOSE: Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS: This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS: The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS (P < .000). CONCLUSION: Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.

AB - PURPOSE: Escalated BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) improves overall survival (OS) in patients with Hodgkin lymphoma (HL) relative to ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) therapy. However, the associated higher cost and toxicity discourage clinicians from prescribing it. Identifying high-risk patients and administering escalated BEACOPP remains an effective strategy. We assessed the significance of interim positron emission tomography (iPET) scan after 2 cycles (iPET2) in identifying this high-risk subset. PATIENTS AND METHODS: This cohort study used secondary data from 12 tertiary care centers in South India gathered over 10 years (2008-2018). OS, event-free survival (EFS), determinants of EFS, and complete response (CR) in iPET2 were assessed. RESULTS: The study included 409 patients with HL (mean age, 34.5 years; male/female ratio, 1.4:1). The median duration of follow-up was 2.8 years. Of 409 patients, 63% underwent PET-based staging and 37% underwent computerized tomography (CT) staging. Stage IV (28.9%) and bone involvement (9.2%) were seen more often with PET than with CT staging (9.2% and 2%, respectively). Among 171 patients with iPET2 results, 24% did not achieve CR, and no factors were significantly associated. The 5-year EFS and OS rates of the entire cohort were 78% and 97%, respectively. The 5-year EFS and OS rates of patients with CR on iPET2 were 90% and 99%, respectively, whereas these were 65% and 100%, respectively, for patients not achieving CR. On univariable analysis, sex, stage, and iPET2 response significantly predicted inferior EFS. On multivariate analysis, only iPET2 response significantly predicted EFS (P < .000). CONCLUSION: Our study supports the use of PET for staging and iPET2 for response assessment. Nonachievement of CR on iPET2 indicates unfavorable outcome, and such patients may benefit from more intensive treatment.

UR - http://www.scopus.com/inward/record.url?scp=85076492231&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076492231&partnerID=8YFLogxK

U2 - 10.1200/JGO.19.00179

DO - 10.1200/JGO.19.00179

M3 - Article

C2 - 31834832

AN - SCOPUS:85076492231

VL - 5

SP - 1

EP - 13

JO - Journal of global oncology

JF - Journal of global oncology

SN - 2378-9506

ER -